Bladder puncture

Indications for the procedure

The primary and only indication for capillary puncture, according to operative surgery guidelines, is acute urinary retention accompanied by the complete impossibility of performing standard catheterization. This clinical situation occurs with severe urethral obstruction (stricture or blockage of the urethra).

It is important to clearly differentiate conditions when making a diagnosis. This surgical intervention is not performed for such pathologies as:

• Pyuria (presence of pus in the urine);
• Urinary incontinence;
• Hematuria (presence of blood in the urine).

The main task of the physician in urethral obstruction is to urgently relieve the overdistended organ, bypassing the natural urinary tract.

Patient preparation and instrument selection

Before starting the surgical manipulation, it is necessary to position the patient correctly. The patient should lie supine with the pelvis slightly elevated. This position ensures optimal placement of the pelvic internal structures for safe access.

The intervention does not require general anesthesia; exclusively local anesthesia is used.

Special attention is paid to the choice of surgical instruments. Only a thin-gauge needle is used for the puncture. The use of a thin needle serves as the main preventive measure against a severe complication: urine leakage into the prevesical tissue. A narrow wound tract collapses faster and minimizes the risk of infection in surrounding tissues.

Topographic landmarks and insertion technique

The success of the surgical procedure largely depends on the accurate determination of the access point and compliance with instrument insertion angles. The puncture is performed strictly along the midline of the abdomen. The topographic landmark is the pubic symphysis (symphysis pubica).

Before inserting the needle, the surgeon must shift the skin over the symphysis. This is a critically important step in the technique. Shifting the skin layers is necessary to create a so-called tissue "lock" after the procedure is completed and the needle is withdrawn. When the skin returns to its original position, the wound tract becomes angled, which reliably seals the puncture site.

Penetration and evacuation of contents

After shifting the skin, the needle is inserted into the tissues. The direction of the instrument must be strictly perpendicular to the patient's body surface. Inserting the needle upward and backward at a 45-degree angle or parallel to the body surface is an error; only a perpendicular vector ensures safe entry into the cavity of the overdistended organ.

The insertion depth ranges from 6 to 8 centimeters. After reaching the required depth, fluid evacuation begins. In most cases, urine begins to flow passively. However, if no passive flow is observed, a special suction device must be connected to the needle.

Class and exam questions

What else to study on this topic

• Topographic anatomy of the prevesical tissue and risks of urine leakage.
• Causes of urethral obstruction leading to the impossibility of catheterization.
• Biomechanics of tissue "lock" formation upon skin shifting.
• Features of local anesthesia administration before puncture.
• The operating principle of active fluid suction devices in surgery.

Other topics in the section «Pelvic and Perineal Surgery»

Prepared by WhiteCoat Pro faculty in accordance with the medical school curriculum. For educational purposes only.